Men’s health physio to improve YOUr sex life

• Do men have a pelvic floor?  
• Can men have the same problems as woman such as urinary and bowel incontinence, prolapse? 
• Can men have sexual issues?  
• Can a men’s health physio help with these?  

The answer is YES!  

Knowing your body, your pelvic floor and how it works can help improve:  

• Your bladder control:  

If you present urinary leakage, post-voiding dribble, urgency, frequency (day and/or night), 

if you feel your bladder doesn’t empty completely,  

if the flow is weak or intermittent,  

if you have to strain to start or finish to wee,  

NB: It’s always a good idea to have a regular prostate screening, just the PSA level in your blood – no panic, you don’t need an internal examination if you don’t have any history or symptoms, and your PSA level is normal. It’s recommended from 45-year-old onwards to exclude any risk of prostate cancer.  

• Your bowel control:  

If you have bowel leakage or having to wipe a lot, hard to make the difference between a wind and a stool, urgency, constipation and straining, …  

Men don’t have prolapses as women can have, mostly because they don’t have a uterus and vagina. However, if the abdominal pressure isn’t controlled correctly (when coughing, sneezing, lifting, exercising…), that pressure can go towards the abdominal wall and a hernia could pop out (umbilical, inguinal or along the midline of your abdomen).  

These symptoms are pretty common and can be improved with pelvic floor and core exercises.  

But most people don’t know that pelvic floor training can help their sexual life too.  

Most men, at some point of their life, will experience some sexual issues with the prevalence getting higher with age and when they present risk factors: diabetes, cancer, stroke, hypertension, high cholesterol, penile trauma, depression, anxiety, drugs, …  

To be considered problematic, it must occur in at least 75% of sexual encounters for a period of at least 6 months according to DSM-5 criteria. 

• Erectile dysfunction (ED)  

= not being able to get and/or keep an erection firm enough for sexual activity.  

In a study, 52% of men aged 40 to 70 describing some degree of erectile dysfunction but the number is probably higher as many men don’t talk about it.  

The first thing is to know where it could come from because the management can be different:  

• If it’s coming from the risk factors (disease, surgery), can you try to stabilise them. For example: control your diabetes or high blood pressure with diet and physical activity.  

• If it’s from a specific medication, maybe you can ask your GP if you could try another molecule or brand and see if you have less side-effects. The main ones are blood pressure, antidepressant and anxiolytic drugs, diuretics. 

But sometimes, physically everything is fine but you still have trouble.  

• It can be psychological or behavioural.  

It can happen in different situations: it can work when you’re by yourself but not with a partner, or it can work with one partner but not another one, or it can depend on the situation, the place, if you’re scared someone might see you or the kids are sleeping next door, …  

A men’s health physio can help you understand your pelvic area, how to control your pelvic floor muscles (the contraction and the relaxation) and give you some tips.  

Here’s some basic exercises you can start with:  

• Belly breathing: don’t force it, it’s all about relaxation!  
  • when you inhale, let your tummy stretch out
  • when you exhale, let your tummy come back in  

• Pelvic floor contractions:
  • on/off: squeeze and relax 
  • 10 seconds: squeeze, hold for 10 sec, relax  
  • Long ones: squeeze, hold for as long as you can (aim for 1 minute)  

=> Increasing the strength and endurance in your pelvic floor can help maintaining the erection  

• Pelvic tilt: tilting your pelvis forward and back, without tensing too much your tummy, bum or legs  

=> That’s the movement you’re doing during intercourse 

• Penetrate when the arousal is at its maximum (if you go in too quickly because you’re afraid of losing it, you will)  

Other treatments:  

• Improving your lifestyle: normal weight, good diet and hydration, moderate alcohol consumption, regular physical activity, no smoking  

• Medication: Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra) (ask your GP – you can ask your physio for information but we can’t prescribe anything)  

• Mechanical devices: penile pump or injections (intercourse is possible even if you don’t have the nerve control anymore. Usually, after surgery or trauma) 

• Surgery  

• Mental health counselling: for anxiety, depression, couple/relationship issues  

• Premature ejaculation (PE)  

= lack of ejaculatory control associated with distress (within approximately 1 minute following vaginal penetration and before the individual wishes).  

The prevalence is 1 man/3.  

It can be a primary (there since the first time) or secondary process (had normal activity before), each time or situation-dependant (same as above for ED)  

There are many psychological factors but none officially validated by research:  

• Depression 
• Poor body image  
• Performance anxiety  
• Relation with the partner  
• History: was sex a taboo when you were a child? how was your first time? 

Here’s some tips and exercises:  

• You can’t control the ejaculation (it’s a reflex) but you can control the excitation 

• Focus on the general relaxation (pelvic floor, legs, bum, tummy, shoulders, jaws)  

• Belly breathing (see above)  

• Pelvic floor gentle contractions but fully relaxing after  

• Gentle pelvic tilts coordinated with breathing  

• Behaviour changes:  

• • Penetrate when not fully excited 

• • Exhale-tilt pelvis-penetrate, inhale-arch-depenetrate,  

• • Stop and start: a few movements, a pause, a few movements, a pause to let the pressure decrease a bit  

• • Positions: avoid missionary (that’s the worst one! You’re in constant tension),  prefer spooning, cowgirl (woman on top), doggy style or sitting 

Other treatments:  

• Mental health counselling: alone or with your partner  

• SSRIs as first line medication (antidepressants)  

It’s possible to have a combination of erectile dysfunction and premature ejaculation.  

Men can be so afraid of losing the erection that he ejaculates quickly.  

Other problems that could affect your sexual life:  

• Pelvic pain, painful ejaculation (17%)  
• Delayed orgasm or anorgasmia (12-20%)  
• Peyronie’s disease: curvature in the penis (up to 13%)  

Whichever your problem is, the most important factor to speed the recovery is the communication with your partner.  

Don’t be scared to talk to them about your fear, how you feel, ask they how they feels about it (you would be surprised how understanding people can be about it).  

It can help alleviate the pressure you put on yourself and you can discuss together what you can try or change.  

And sometimes, who knows, changing the routine can reignite the passion 😉